Monday, November 23, 2009

When an information disconnect does not create cognitive dissonance

Is it rare for an information disconnect to be accompanied by a complete absence of cognitive dissonance? And does such an absence signal mere ignorance or deliberate intellectual dishonesty? There is such a gap present in our healthcare debate.

Think about this. The Republican Party has always touted itself as a fiscally responsible party. Under this banner they like to cut taxes and minimize what they call "entitlement" programs (these of course are just the programs that provide a modicum of support for those left out of our consumerist equation). So, given this as a top priority in the hierarchy of their agenda, there is no contradiction in their stance against public coverage of healthcare in the US. OK so far?

Well, here comes the disconnect (no pun intended): they do not wish to limit any and all existing and future healthcare interventions for our public, including the Medicare population. They have made up rows of dying grandmas whose ventilator access is rationed by the government death panels, and have equated the proponents of rational rationing with the Nazis. So, where is the disconnect? Well, given that Medicare expenditures have been growing at rates far outpacing the US annual inflation (up to 12% in some years), how do we propose to pay for this escalation if we are unwilling to limit care? Well, one way is by raising taxes. This thought, of course, sends the Republicans sobbing into their hankies -- such a solution is anathema to their pseudo-science of supply-side economics. In the meantime, a few years ago they added to the Medicare bill by creating Medicare Part D, or prescription drug coverage. In and of itself, this coverage is a good idea. Unfortunately, Medicare is not empowered to deny coverage based on cost or cost-effectiveness, and it is further prohibited from negotiating drug prices. Well, in 2006 this program cost Medicare over $40 billion. And George W. Bush insisted on lowering taxes at the same time. And he started two expensive wars, too. So, am I just dense because I cannot get these numbers to add up? Am I missing something that is indeed fiscally responsible about the Republican stance? Why does this disconnect not create any visible cognitive dissonance for them?

I think I know why. They are not the party of fiscal responsibility, but the party of survival of the fittest consumer. An entitlement program creating corporate profit is good, while one geared at improving our society is a manifestation of the Nanny state. In fact, the Nanny state has run rampant in the last 30 years wiping noses of our corporate giants with their supply-side religion, while shaking off the needs of the public as socialist propaganda. There is no fiscal responsibility here, only the single-minded pursuit of more for less. The US currently has a $12 trillion (this is worth writing out just for its shock value: $12,000,000,000,000) debt on the books. This does not take into account what is already committed to future debt, which by some accounts exceeds utterly unimaginable $60 trillion. In fact, by 2019 the US government's annual interest on its debt will be $500 billion more than it is today, going from $200 to $700 billion! Just the interest, folks!

So, while I can almost intellectualize the Republicans' selfish desire to keep 46 million people in the US from availing themselves of healthcare, I deplore their dishonesty in hiding behind the aegis of fiscal responsibility. The last time our budget was balanced, a Democrat was in the White House. A Republican started an ill-conceived war and cut taxes at the same time -- this is living in a fantasy of a most destructive kind! So, don't make the healthcare bill about anything other than what it is about: the potential profit to be made from keeping healthcare status quo on the backs of growing numbers of citizens of our nation. It makes you look not only hypocritical, but also supremely stupid!

Welcome and a disclaimer

Welcome to my blog, "Healthcare, etc."! In this blog I take the perspective of a researcher/policy wonk rather than an individual healthcare practitioner. Therefore, all opinions that I express and generalizations that I make about any issues will in no way be construed as medical advice for individual visitors / readers. All views expressed here are solely my own, and do not represent opinions of any organizations with which I am affiliated. I welcome all comments, but reserve the right not to publish paranoid or abusive rants or overt marketing pitches.

About Me

I am an independent physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. I am also a professor of Epidemiology at the University of Massachusetts, Amherst.
I am frequently invited to speak about evidence-based medicine, methods and healthcare-associated complications.
My posts have been syndicated on The Health Care Blog, KevinMD,The Healthcare Collective and other sites. They have also been cited in the New York Times. Occasionally you can also find me blogging on the British Medical Journal blog site http://www.doc2doc.bmj.com
If you would like to contact me about my research, blog posts or speaking, please e-mail me at Healthcareetcblog@gmail.com